oncology and palliative care

Question 1

palliative care hyoscine syringe drivers

Answer 1

respiratory secretions: hyoscine hydrobromide

Bowel colic: hyoscine Butylbromide

Question 2

oral to sub cut potency ration of morphine

Answer 2

1:2 (1:3 Diamorphine)

Question 3

opioids of choice for pain relief in palliative care patients with severe renal impairment

Answer 3

Oxycodone and methadone

Alfentanil, buprenorphine and fentanyl

Question 4

breakthrough dose of morphine

Answer 4

1/6 of daily morphine dose

Question 5

treatment of mausea

Answer 5

ondansetron- chemo 5HT3 (antagonist)
dexamethasone- raised ICP
cyclizine- motion sickness
haloperidol too

Question 6

terminal agitation rx

Answer 6

subcut midazolam

Question 7

tx options for metastatic bone pain

Answer 7

radiotherapy, analgeseia, bisphosphonates

Question 8

intractable hiccups rx

Answer 8

chlorpromazine, haloperidol

Question 9

tramadol/ cocodamol to morphine conversion factor

Answer 9

divide by 10

Question 10

Which chemo drug peripheral neuropathy. Urinary hesitancy may develop secondary to bladder atony.

Answer 10

vincristine

Question 11

chemo drug that causes cardiomyopathy

Answer 11

doxyrubicin

Question 12

chemo drug- myelosuppresion, oral mucositis, liver fibrosis, hypomagnesaemia

Answer 12

methotrexate

Question 13

strong family history of breast cancer (mum and maternal aunt)

Answer 13

p53 germline mutation- Li Fraumeni syndrome

Question 14

alpha fetoprotein is a tumour marker for

Answer 14

hepatocellular carcinoma, teratoma

Question 15

mx of spinal cord compression

Answer 15

high dose dexamethasone,

radiotherapy/surgery

Question 16

lung cancer types

Answer 16

squamous- central, PTHrP, clubbing
adenocarcinoma- peripheral, most common in non-smokers
large cell- peripheral, poor prognosis, ?BHCG
small cell- near larger airways, paraneoplastic syndromes

Question 17

gardners syndrome

Answer 17

autosomal dominant
colonic polyps
associated with thyroid cancer
APC gene on chr 5
most patients undergo colectomy

Question 18

investigation in female in metastatic disease of unknown primary

Answer 18

ca125

Question 19

kartageners syndrome

Answer 19

immotile cilia

situs invertus

Question 20

MEN 2 (PTC)

Answer 20

phaeo (adrenals)
amyloid producing medullary thyroid carcinoma
parathyroid

Question 21

MEN 1

Answer 21

pituitary, parathyroid, pancreas

Question 22

chemo drug that causes lung fibrosis

Answer 22

bleomycin- degrades preformed DNA.

cytotoxic antibiotic

Question 23

calcitonin tumour marker fore

Answer 23

medullary thyroid cancer (parafollicular cells)

Question 24

brca2 associated with

Answer 24

prostate cancer

Question 25

cyclophosphamide mechanism and side effect

Answer 25

alkylating agent- cross linking DNA

haemorrhagic cystitis, myelo suppression

Question 26

PET scan: how does it work and why used

Answer 26

FDG marker, shows glucose uptake. Marker of metabolic activity to find primary and mets

Question 27

follow up markers for testicular cancer

Answer 27

AFP, BHCG